Provider Demographics
NPI:1528405693
Name:FREEMAN, KATY ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:ANN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2130
Mailing Address - Country:US
Mailing Address - Phone:217-417-7055
Mailing Address - Fax:
Practice Address - Street 1:500 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-1139
Practice Address - Country:US
Practice Address - Phone:812-917-2320
Practice Address - Fax:812-917-2320
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL224Z00000X
IN32002473A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant